MEDICARE: LYNN R JOHNSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	9701780	NC
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	9701780	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00303989	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1508835091	OTHER	NC	TRICARE
4	195409	OTHER	NC	MEDCOST
5	11578	OTHER	NC	BCBS OF NC

General Provider Information

NPI Number	:	1508835091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN R JOHNSON MD

Provider Business Mailing Address
First Line	:	2080 W ARLINGTON BLVD STE B
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-3770
Country	:	US
Telephone Number	:	252-752-2140
Fax Number	:	252-689-6502

Provider Business Practice Location Address
First Line	:	2080 W ARLINGTON BLVD STE B
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-3770
Country	:	US
Telephone Number	:	252-752-2140
Fax Number	:	252-689-6502

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	04/07/2021

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Directions to “ LYNN R JOHNSON MD” Practice Location

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